One critical aspect of health-services delivery is physician-patient communication because patient-centered communication patterns strongly influence patients'psychosocial health outcomes, such as anxiety, depression, uncertainty, and coping. One key element of patient-centered communication is whether or not patients actively participate. 'Communication-participation'behaviors include patients proactively initiating topics and independently directing conversations (e.g., asking questions), and physicians facilitating such behavior (e.g., asking patients if they have questions and involving patients in decisions). This study extends research on communication-participation behavior into treatment-decision-making conversations between newly diagnosed, female, breast-cancer patients and surgeons. The specific aims of this study are: (1) to qualitatively advance the measurement and conceptual understanding of 'communication-participation'variables;and (2) to quantitatively test the associations between 3 'communication-participation'variables and 4 psychosocial health outcomes (i.e., patients'cancer coping, cancer-health uncertainty, satisfaction with surgical treatment plans, and satisfaction with surgeons). To accomplish these aims, we propose an exploratory and observational study of naturally occurring treatment-decision-making conversations between 15 surgeons and 180 patients (12 patients per surgeon). We will administer surveys to patients immediately pre- and post visits, and videotape, transcribe, and code treatment-decision-making conversations. The long term goals of this project are to facilitate the design of efficacious communication interventions at the level of both surgeons and patients, and to lay the groundwork for securing R01 funding. PUBLIC HEALTH RELEVANCE: Breast cancer is the second leading cause of death due to cancer in women. The diagnosis of breast cancer causes women to suffer from a range of ill psycho-social effects, which can indirectly contribute to breast- cancer recurrence and/or mortality. Certain patterns of surgeon-patient communication can improve women's ability to cope with their breast cancer, which can offset its ill psychosocial effects. If this study is effective in isolating communication patterns that improve patients'psychosocial health, it will lead to the development of a communication-training program to address this critically important public health problem in the United States.